The Preconception GuideThe Preconception Guide

The Preconception Guide

The journey to parenthood can start long before a plus sign on a pregnancy test.

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Fertility is a complex picture with many important things to consider and no single factor can predict your ability to conceive. Fertility is personal. General health, lifestyle and, of course, age, can all play a part, but, statistically, if you are under 40, have ovaries, and are having sex regularly with a person with sperm, you have an 8 in 10 chance of becoming pregnant in the space of a year. However, It is also statistically true that 1 in 6 couples are affected by infertility (defined as the inability to conceive a pregnancy after 12 months of unprotected sexual intercourse) and 1 in 10 experience secondary infertility.

In preparing to conceive, and in turn, for pregnancy, there’s a lot you can do to understand your body, get it in top condition for conception and understand options for having a baby. Whether you’re considering, planning or trying, for your first baby or your fourth, this guide is your starting point.

Before you get started, it's important to note that trying to conceive can be an emotional rollercoaster. One that resets to take you back through it every 28 days. Knowledge is power, but a lot of information can sometimes feel overwhelming. This guide contains a lot of information, so if it’s feeling like a lot, take it a bit at a time (it’s not going anywhere) or use the navigation on the left to jump to relevant sections. 

Getting the knowledge

Healthcare in Australia is often reactive. Information about our own personal fertility health can feel gatekept with “give it 12 months” or “wait and see”, needing a problem before we can seek information to guide a solution. But fertility is a timed event. Gaining insight into your body at the start can have a huge impact on how you get to the end. 

The reason age is the most important factor in fertility is because a woman is born with all the eggs she is going to have in her lifetime (1-2 million) and that number decreases with age, as does the quality of the eggs. By the time you hit puberty about 25% remain (still around 250,000). They decrease steadily into your mid 30s, during which a woman has a 20-25% chance of getting pregnant each month. After 35 the decline speeds up until around age 50, when a person with ovaries typically reaches menopause (which means the egg count has reached zero.) 

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While the connection between age and fertility in women has long been known, more recent studies have found men are also affected. Male fertility generally starts to reduce around age 40-45 when sperm quality decreases. Advanced male age reduces the overall chance of becoming pregnant and increases risks to the foetus and, though rare, the subsequent child’s mental health.

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Circumstantial Factors

The world favours a planner, so if you are considering having a baby, it’s helpful to think about how it will affect your life-on-paper, understand your entitlements and make adjustments to get the most out of your options.

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Workplace entitlements

Assuming you meet the requirements, the Australian government will pay 22 weeks of parental leave, at the national minimum wage (currently $740.60 per week, before tax). On top of this, most employers will fund Parental Leave under their own scheme. These vary greatly from workplace to workplace, as do the requirements to access them, so understand your own and, if relevant, your partner’s policies. 

Some workplaces also have leave entitlements specific to IVF (in vitro fertilisation), miscarriage or bereavement. Others offer financial reimbursements for fertility treatments like egg freezing or IVF and other family-building expenses like adoption and surrogacy. Google currently offers employees up to $33,200 in lifetime support to a household, while Apple and Meta offer $30,628 for egg freezing. It’s not just tech companies with these policies in place, so look into your policies or speak with your HR department.

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Health insurance

It is one of the great idiosyncrasies of life, that you need to have pregnancy covered in your health insurance before you get pregnant. About 12 months before you give birth if you are looking to receive private care during your pregnancy or birth. Read more about choosing where to give birth in The Labour & Birth Guide 

Health factors

When considering conceiving, an appointment with your GP is one of the first ports of call. This is to make sure everything is in check and you’re set up for success. You’ll be asked about medical and reproductive history, your own and your family’s as well as lifestyle: exercise, diet, weight. You’ll be advised to get your vaccinations up to date: hepatitis B, measles, mumps, varicella, rubella, as well as the influenza vaccine and the adult pertussis dTpa vaccine.

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It’s also wise to get an STI check. One in two sexually active people will contract a sexually transmitted infection before age 25. Many STIs are easily treatable, but you don’t always know you have them. STIs like chlamydia (which is the most common) and gonorrhoea, don’t always present with symptoms. If left untreated, STIs can impact your ability to get pregnant and can increase risks during pregnancy and delivery.

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You may be surprised to hear a dental check-up is on your preconception to-do list, but it is. Pregnancy hormones affect both gums and teeth. In fact, studies have found links between pregnant women with severe gum disease and premature birth. You’re also more likely to have dental issues during pregnancy like gingivitis and teeth movement occuring.

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Fertility Tests

While no one test can predict your ability to conceive, your fertility hormones can reveal much. Egg count, sperm count and quality, ovulation and any red flags (often treatable) that might be getting in your way. Testing will help you understand what’s happening inside your body.  

Genetic Screening

You may be a carrier for a genetic condition such as cystic fibrosis, spinal muscular atrophy and fragile X syndrome without knowing it, as just being a carrier does not mean you must display the condition. Around 5% of people in Australia will carry a mutation for one of these conditions. One in 240 couples will both be carriers. In this case, the chance of your child being born with the condition is greater. A reproductive carrier screening is a blood test of both biological parents. It looks at your genes for variants or mutations to find any conditions you may be carrying. With both parties tested, it can determine the chance of those people’s eggs and sperm creating a child with common serious genetic conditions.

If you have ovaries

Fertility for women relies on the ovaries releasing healthy eggs. The reproductive tract must let an egg pass into the fallopian tubes and join with sperm. Then the fertilised egg must travel to the uterus and attach to the lining. Tests for female infertility try to find obstructions to any of those steps.

Egg Count Check

An egg count (or AMH test) is often one of the first things a fertility specialist will want to understand when assessing your fertility because having an egg available to be released and fertilised is one of the keys to being able to conceive. Your eggs grow inside of follicles in your ovaries and each follicle produces a hormone called Anti-Mullerian hormone (AMH). When we want to estimate egg count, it's impossible to actually count the number of eggs because they are too small. So instead, the amount of AMH in the blood is measured and we use this to estimate the number of follicles – and therefore the number of eggs you have. This is similar to how a blood test to check for pregnancy measures the amount of hCG (human chorionic gonadotropin) hormone present, not the actual foetus. 

WHEN Fertility Egg Count Check is Australia’s first at-home AMH test. It allows you to take your own blood samples (via fingerprick) and receive clinical grade results with commentary from leading fertility specialists. 

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An AMH test will: 

  • Estimate your egg count and if you have more or less than the number of eggs that are expected for your age.
  • Will help you understand if you are at risk of having a shorter reproductive window and and running out of eggs earlier.
  • Help you understand if a doctor might retrieve more or fewer eggs than what would be expected for someone of your age in any cycle of egg freezing or IVF.

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An AMH test will not:

  • Tell you the quality of your eggs.
  • If and when you will become pregnant.

Other Blood Tests

Further to AMH-testing, blood tests can look into a number of hormones related to your fertility and identify any factors that may impact your fertility. Here’s a rundown of each:

  • Androgens are often elevated for women navigating ovulation problems or conditions such as PCOS.
  • Follicle-stimulating hormone (FSH) is responsible for stimulating the growth of the follicle containing the egg.
  • Luteinising hormone (LH) helps to stimulate the rapid growth of the follicle that contains the fertile egg just prior to ovulation.
  • Progesterone which fluctuates and can confirm check ovulation.
  • Prolactin is the hormone that is usually elevated during pregnancy and plays a key role in preparing the body for breastfeeding.
  • Thyrotrophin is a hormone that can show if our thyroid gland is underactive (which can lead to thyroid problems and irregular periods).

Pelvic & Transvaginal Ultrasound

An ultrasound scan of your ovaries, uterus and fallopian tubes can identify possible fertility issues in your reproductive organs such as blockages in the fallopian tubes (which could stop eggs from travelling along the tubes and into the womb) or conditions like endometriosis and fibroids. A transvaginal ultrasound uses a small ultrasound probe inserted in your vagina to examine.

X-ray

A hysterosalpingogram is an X-ray of your womb and fallopian tubes after a special dye has been injected. It can be used to find blockages in your fallopian tubes, which may be stopping eggs travelling along the tubes and into your womb.

If you have sperm

Sperm Analysis

Two in every five cases of fertility problems are caused by the male partner, so it’s just as important to test semen (the white fluid ejaculated from the penis) and sperm (a component of semen fundamental in conceiving) as eggs. Sperm analysis can tell you semen volume as well as sperm concentration, mobility and morphology (or shape, it needs to be the right shape to penetrate an egg). 

Blood test

As with women, a blood test checks for hormonal imbalances that could be affecting fertility. 

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Getting your body ready

Increasingly research is finding the significant impact lifestyle factors can have on your fertility. By “lifestyle factors”, we mean modifiable habits and ways of life, think diet, fitness, psychological stress and environmental exposures. Unlike your egg count and age, which are set, these are the areas you can be really proactive in changing to give yourself the best chance at conception. Here’s the data-backed information you need to know to make decisions.

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Chill on caffeine, cigarettes and alcohol

Things that are bad for your general health, are, no surprises, also not good for your fertility health.

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Smoking

In both men and women, smoking, be it first or second-hand smoke, can negatively impact each step of the reproductive process for both men and women. Cadmium and cotinine are two specific toxins found in tobacco smoke that can reduce sperm quality and egg production (including AMH levels). Other impacts of smoking on fertility include increased sperm DNA damage and reduced fertilisation and development potential, culminating in lower pregnancy rates. One study of 1786 men found that smoking was associated with decreases in sperm density (15.3%), total sperm counts (17.5%), and total motile sperm (16.6%) compared with nonsmokers. Another found that the relationship between smoking and sperm concentration was dose-dependent. Meaning the more you smoke, the more harm it’s doing. Men who smoked more, in this case, over 20 cigarettes a day experienced a 19% reduction in sperm density. 

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The first studies assessing vaping and fertility also links it to lowering the AMH hormone, and smoking other substances can also negatively impact fertility. It is advised that anyone wanting to conceive quits all forms of smoking or vaping.

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Studies have shown that women who smoke are more than 50% less likely to conceive naturally, compared to non-smokers.

Alcohol  

If you’re trying to conceive, it’s advised to not to drink alcohol at all. The biggest reason is because there is no ‘safe’ level of alcohol to drink when you are pregnant and if you become pregnant, you may not know for the first few weeks after conceiving, therefore the safest thing to do is not drink any alcohol while you are trying for a baby. Among other risks, drinking when you’re pregnant can increase the risk of Foetal Alcohol Spectrum Disorder as well as the chance of miscarriage. Like with smoking, the risks increase the more you drink. 

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On top of this, male or female, if you drink heavily (more than 14 units a week), it may be more difficult for you to conceive. For women, heavy drinking may contribute to period problems, such as heavy, irregular or no periods. This can make it more difficult to get pregnant because you may not ovulate regularly. In men, drinking too much alcohol can cause a loss of interest in sex, problems with having an erection, less testosterone (a hormone that is important for conception) and problems with sperm quantity and quality. Stopping or cutting right back on alcohol can improve your fertility and overall health.

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Caffeine

Notably, and thankfully, drinking coffee is not a totally no-no for fertility. What studies have shown is that an excess of caffeine can negatively affect your fertility, but a lower caffeine intake, below 200-300mg a day, has no effect. Experts recommend limiting your intake to one or two small coffees a day. Just be wary that different cafes have different rules for how many shots goes in what and different coffee beans have different caffeine amounts.

Stress

The impacts of stress on our health (including fertility health) have been debated for years. Women with infertility report elevated levels of anxiety and depression, so it is clear that infertility causes stress. What is less clear, is whether or not stress causes infertility. However, the most recent research has documented the efficacy of psychological interventions in lowering psychological distress as well as being associated with significant increases in pregnancy rates. 

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Essentially, your body (including your ovaries) feel what you think. It knows when you’re stressed and it doesn't handle it well. When you’re stressed, your body goes into fight or flight mode and the systems in your body that aren’t necessary for survival shut down. Effectively, stress can shut down your reproductive system. 

So if you want to conceive, eliminating known stressors can help. This may mean minimising contact with certain people or situations, getting help with your responsibilities or taking up something that helps you take the stress out of your obligations, like yoga or meditation. Everyone’s load and how they feel about it is different, so making changes to make life more peaceful is a very individual process. Find what works for you.

BMI and exercise

Being underweight or overweight can impact your fertility, because it can cause menstrual disorders, problems with ovulation and hormonal imbalances. What a healthy weight looks like is different for everyone and is a discussion to have with your doctor. It’s very important to remember that being outside of benchmarked BMI or body fat percentages does not mean you can’t conceive, it just makes it a little harder. 

Exercise can help you get to those optimal fertility benchmarks, and also has been, in moderation and regularity, shown to improve fertility in all women. The exercise you do can be anything as long as it keeps your body moving at a comfortable pace. Even better if it’s something you enjoy. Two notes on this, the benefits of exercise for fertility health have been shown to be even greater in women with PCOS or other reproductive conditions, and it is important that you do not over-exercise, which can have a negative effect on your fertility as your body can respond to exhaustion with irregular periods. There is a term for this situation: athletic amenorrhoea. You want moderately-intense exercise and no more than 7 hours a week of it. 

Supplements

It is recommended that you start taking a prenatal supplement three months before actively trying to conceive so that you are getting the additional nutritional needs demanded of growing a child by the time they are needed. Pregnancy requires vitamins and nutrients in high amounts that are extremely difficult to get from just your diet.

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Prenatal supplements became popular in the ‘80s when the strong correlation between the presence of Folic Acid in multivitamins and the health of a developing foetus became known. In short, adding Folic Acid to a woman’s diet resulted in a reduced risk of major neural tube defects (NTD’s) including spina bifida (a spinal cord defect) and anencephaly (a brain defect), both of which occur in the early weeks of pregnancy.

Folic Acid is a synthetic form of Folate (B9). It is the form of folate originally included in prenatal vitamins and found to have benefits however one in three women can’t actually absorb folic acid due to a genetic mutation known as the MTHFR-gene. While research into newer forms of folate like Methylated Folate and Folinic Acid (both of which everyone can absorb) is light, it supports that it has the same benefits as Folic Acid. Speak to your doctor about your preferences, both prenatal supplements with Folic Acid, Methylated Folate and Folinic Acid are available, as are prenatals for men.

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Fertility-friendly foods

Nutrition can play an enormous role in your fertility as good nutrition habits can support regular ovulation, improve egg and sperm quality and reduce your risk of pregnancy complications. 

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Nourishing your body with whole unprocessed foods with lots of fibre, healthy fats and adequate protein are essential for optimising the health of your microbiome, reducing inflammation, supporting your immune and hormonal system which leads ultimately to healthy ovulation and eggs. 

Sperm health is also affected by diet with many studies that show poor diets low in fruit and vegetables, high in sugar and unhealthy fats (found in fried foods) may reduce sperm quality and quantity.

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Plastic

BPA, or Bisphenol-A, is a chemical used to make plastic hard and unbreakable. It’s found in all sorts of household supplies but studies have shown that it can interfere with the endocrine system which is a crucial part of the body’s hormonal system and directly impacts fertility. When trying to conceive, consider switching to BPA-free plastic containers or glass and stainless steel options, or at least avoid storing or microwaving food in plastic takeaway containers.

Getting down to business

Pregnancy occurs when an egg is met, and fertilised, by sperm (this is conception). The fertilised egg is then an embryo and is implanted into the uterine lining where it becomes a pregnancy.

Now, there’s more than one way to get sperm and eggs. More than one way to get them together, and more than one way to get that fertilised egg implanted in a uterine lining, but the basic science stays the same. Here we’ll take you through your conception options and what to know when trying and timing to conceive.

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Natural Conception

Natural conception is the reproductive process between a heterosexual couple when sperm enters the vagina, travels through the cervix into the uterus (womb) and to one of the fallopian tubes, where fertilisation of a mature egg occurs. The resulting embryo then travels to the uterus and attaches to the uterine wall for pregnancy.

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For this to occur, you need to have sex when an egg has been released from the ovaries, also known as ovulation. 

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Understanding your ovulation cycle

While for heterosexual couples it is recommended to have sex every 2-3 days if you are trying to conceive, you can only get pregnant during certain days in your cycle. These days are your “ovulation window” and refer to the three or so days around when you ovulate. This is when you are most fertile a.k.a likely to get pregnant. However ovulation windows aren’t the same for everyone. If you have regular, predictable menstrual cycles, your ovulation window is often a halfway point in your 28-day cycle.

You can also predict your ovulation cycle by:

  • Cervical mucus: When you ovulate, your cervical mucus (which you may find in your underwear sometimes) is clear, stretchy and slippery. When you see it, it’s your most fertile time.
  • Body temperature: Your body temperature spikes when you ovulate, so if you consistently check your temperature at rest (ideally when you first wake up) you’ll be able to predict when you’re in your ovulation window.
  • Ovulation tests: These are urinary tests that identify the LH hormone which spikes 24-48 hours before you ovulate. Using all three methods as well as tracking your cycle consistently is the best way to identify the best time to have sex to conceive. 

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Baby-making sex

To give yourself the best chance of conception and make the most of your ovulation and most fertile window (3-5 days before you ovulate until 24 hours after), try to have sex several times within it.

You don’t have to do anything special or different to how you and your partner already enjoy sex. There are no particular positions that increase your chances of pregnancy, a woman doesn’t have to orgasm (though it can’t hurt) and you don’t need to lie with your legs up the wall or refrain from showering after (it won’t help get the sperm to the egg).

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Assisted conception

There are many procedures that can assist in conception and this is not a complete list as each of these are an option based on your unique situation. Your own GP or fertility specialist may suggest what options are relevant to your situation before you come to assisted reproductive treatment (ART) procedures in which eggs are fertilised outside the body. The two ARTs are IVF (in-vitro fertilisation) and ICSI (intracytoplasmic sperm injection). ARTs are used when sperm donors, egg donors or a gestational surrogate are part of your journey to have a child, or when a heterosexual couple choose to most usually because of difficulty with natural conception.

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IVF is used for female infertility or unexplained infertility, and ICSI is used when there is male infertility. The steps however, are mostly the same.

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  • Hormone stimulation: The woman’s ovaries are stimulated with a course of injectable fertility drugs to encourage eggs to exit the ovaries.
  • Egg retrieval: When the eggs are mature, they are retrieved while the woman is under light anaesthetic. If you were doing egg freezing (when eggs are collected and stored for later use), they would go to freezing after this step.
  • Embryo development: For IVF, sperm from the male partner or a donor are then added to the eggs to allow them to be fertilised, i.e. IVF eliminates the journey between egg and sperm. For ICSI, the scientist picks up a single sperm and injects it into each egg using a microscopic needle, i.e. ICSI eliminates the journey and the need for the sperm to find its way into the egg. The eggs and sperm are then kept in the laboratory for 2 to 5 days (depending on clinic practice) for embryos to develop.
  • Embryo transfer: if the eggs fertilise and embryos develop, one embryo (sometimes two) is placed in the woman's uterus. If you are doing only embryo freezing, to use for future embryo transfers, this is done at this step. If you are ready for a baby, but several embryos develop, the remaining can be frozen for use in later embryo transfer procedures.
  • Test for pregnancy: Two weeks after the embryo transfer the woman has a blood test to see if the treatment has been successful. If it is positive, after a following two weeks an ultrasound checks that the pregnancy is developing normally. If the test is negative, the woman will have a period and then will need to decide whether to try again. If more embryos were created then she can return to step four, or if there are more eggs but unfertilised, step 3. 

Costs of IVF and ICSI

In Australia, Medicare and private health insurance covers some of the costs associated with IVF and ICSI but there are also substantial out-of-pocket costs. These costs vary, depending on the treatment, the clinic and whether a patient has reached the Medicare Safety Net threshold. It is important to look at associated costs and what rebates or exemptions you may qualify for.

Pregnancy tests

Over the counter pregnancy tests are most accurate on the first day of a missed period. The body needs time to increase its levels of the human chorionic gonadotropin (HCG) which the tests look for in your urine, so testing before a missed period can increase the risk of a false negative.

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Each test is different, so read the instructions specific to your test, but generally you will need to either collect your urine in a cup and dip a testing stick into the liquid, or use an eyedropper to move a small amount to a second container, or place the testing stick into the area of your expected urine stream so that it will catch your urine midstream.

After the recommended waiting time (usually a few minutes), the results will be displayed as a change in colour, line, symbol or the words “pregnant” or “not pregnant”.

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Home pregnancy tests are almost 99% accurate, but it is recommended you see your doctor for a blood test after to confirm a positive result from a home test.

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When it’s not happening

We’re going to say it one more time, fertility is personal. While the probability of couples who are trying to conceive naturally is good (75% within 6 months, 90% within one year), as are that of IVF (though, again, incredibly personal and nuanced so it’s best to calculate your individual IVF success rate), none of that really matters if it’s not happening for you. It can be extremely exhausting and emotional, not to mention physically taxing if you are going through rounds of IVF. It can also feel all consuming and even though someone else’s fertility has zero effect on your own, it can be difficult if others around you are having children while you are not. Give yourself grace, and be kind to yourself. Know that there are many, many paths to parenthood should you wish to explore them, and support is always available.

Read The Pregnancy Guide

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